CONSERVATIVE MANAGEMENT VERSUS LAPAROSCOPIC CHOLECYSTECTOMY IN ADULTS WITH GALLSTONE DISEASE
Main Article Content
Keywords
Gallstone disease, conservative management, laparoscopic cholecystectomy, outcomes, quality of life
Abstract
Background: Worldwide, gallstone disease has a significant impact on healthcare costs. The purpose of this research was to evaluate the effects of laparoscopic cholecystectomy vs conservative therapy in persons with symptomatic gallstone disease.
Methods: Conducted at MD Health Center, Lahore Pakistan, from January 2021 to December 2023, this retrospective cohort study included 108 patients: 54 under conservative management and 54 undergoing laparoscopic cholecystectomy. Data encompassed demographics, clinical presentation, treatments, and outcomes. Primary outcomes focused on complications, symptom resolution, and quality of life, while secondary outcomes included hospital stays, readmission rates, and healthcare costs. Statistical analysis used SPSS version 25.
Results: Laparoscopic cholecystectomy demonstrated significantly lower complication rates (9% vs. 26%, p = 0.015), higher complete symptom resolution (94% vs. 78%, p = 0.025), and superior quality of life improvements (91% vs. 70%, p = 0.006) compared to conservative management. In the laparoscopic group, hospital stays were shorter (2.1 ± 0.6 days vs. 3.8 ± 1.2 days, p < 0.001). Recurrence rates were considerably lower in the laparoscopic group at the one-year follow-up (0% vs. 18%, p < 0.001).
Conclusion: Laparoscopic cholecystectomy emerges as the preferred treatment for symptomatic gallstone disease, offering better clinical outcomes, improved quality of life, and reduced healthcare costs compared to conservative management. These findings advocate for surgical intervention in the management of symptomatic gallstone disease and call for further prospective studies to validate these results and refine treatment guidelines.
References
2. Ahmed I, Innes K, Brazzelli M, Gillies K, Newlands R, Avenell A, Hernández R, Blazeby J, Croal B, Hudson J, MacLennan G. Protocol for a randomised controlled trial comparing laparoscopic cholecystectomy with observation/conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-Gall trial). BMJ open. 2021 Mar 1;11(3):e039781.
3. Mora-Guzmán I, Di Martino MA, Bonito AC, Jodra VV, Hernández SG, Martin-Perez E. Conservative management of gallstone disease in the elderly population: outcomes and recurrence. Scandinavian Journal of Surgery. 2020 Sep;109(3):205-10.
4. Bagepally BS, Haridoss M, Sasidharan A, Jagadeesh KV, Oswal NK. Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy. BMJ Open Gastroenterology. 2021 Jul 1;8(1):e000675.
5. Ahmed I, Hudson J, Innes K, Hernandez R, Gillies K, Bruce R, Bell V, Avenell A, Blazeby J, Brazzelli M, Cotton S. Laparoscopic cholecystectomy versus observation/conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-GALL): a pragmatic, multicentre randomised controlled trial.
6. Haridoss M, Kumar S, Natarajan M, Sasidharan A, Rajsekar K, Oswal NK, Bagepally BS. Cost-effectiveness of cholecystectomy compared to conservative management in people presenting with uncomplicated symptomatic gallstones or cholecystitis in India. Expert Review of Pharmacoeconomics & Outcomes Research. 2023 Feb 7;23(2):215-24.
7. Gutt C, Schläfer S, Lammert F. The treatment of gallstone disease. Deutsches Ärzteblatt International. 2020 Feb;117(9):148.
8. Loozen CS, Oor JE, van Ramshorst B, van Santvoort HC, Boerma D. Conservative treatment of acute cholecystitis: a systematic review and pooled analysis. Surgical endoscopy. 2017 Feb;31:504-15.
9. Bagepally BS, Kumar SS, Natarajan M, Sasidharan A. Incremental net benefit of cholecystectomy compared with alternative treatments in people with gallstones or cholecystitis: a systematic review and meta-analysis of cost–utility studies. BMJ Open Gastroenterology. 2022 Jan 1;9(1):e000779.
10. Sauerland S, Langenbach MR. Managing symptomatic gallstone disease. bmj. 2023 Dec 6;383.
11. Lord AC, Hicks G, Pearce B, Tanno L, Pucher PH. Safety and outcomes of laparoscopic cholecystectomy in the extremely elderly: a systematic review and meta-analysis. Acta Chirurgica Belgica. 2019 Nov 2;119(6):349-56.
12. Ahmed I, Innes K, Brazzelli M, Gillies K, Newlands R, Avenell A, Hernández R, Blazeby J, Croal B, Hudson J, MacLennan G. Protocol: Protocol for a randomised controlled trial comparing laparoscopic cholecystectomy with observation/conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-Gall trial). BMJ Open. 2021;11(3).
13. Chhoda A, Mukewar SS, Mahadev S. Managing gallstone disease in the elderly. Clinics in Geriatric Medicine. 2021 Feb 1;37(1):43-69.
14. Handler C, Kaplan U, Hershko D, Abu-Hatoum O, Kopelman D. High rates of recurrence of gallstone associated episodes following acute cholecystitis during long term follow-up: a retrospective comparative study of patients who did not receive surgery. European Journal of Trauma and Emergency Surgery. 2023 Apr;49(2):1157-61.
15. Kareem A. Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy (Doctoral dissertation, College of Medicine Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy Submitted to the Council of the College of Medicine, Diyala University).
16. Bagepally BS, Haridoss M, Sasidharan A, Jagadeesh KV. Systematic Review and Meta-Analysis of Gallstone-Disease Treatment Outcomes Between Cholecystectomy and Relatively Conservative Approaches. Available at SSRN 3802426. 2021 Mar 11.
17. Alves JR, Klock DM, Ronzani FG, Santos SL, Amico EC. Asymptomatic cholelithiasis: Expectant or cholecystectomy. A systematic review. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 2023 Jul 17;36:e1747.
18. Sutherland JM, Mok J, Liu G, Karimuddin A, Crump T. A cost-utility study of laparoscopic cholecystectomy for the treatment of symptomatic gallstones. Journal of Gastrointestinal Surgery. 2020 Jun 1;24(6):1314-9.
19. van Dijk AH, Wennmacker SZ, de Reuver PR, Latenstein CS, Buyne O, Donkervoort SC, Eijsbouts QA, Heisterkamp J, Janssen J, Nieuwenhuijs VB, Schaap HM. Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial. The Lancet. 2019 Jun 8;393(10188):2322-30.
20. Gurusamy KS, Davidson BR. Gallstone disease. Evidence‐based Gastroenterology and Hepatology 4e. 2019 Apr 23:342-52.
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Nusrum Iqbal
Chairman Department of Internal Medicine, MD Health Center, Lahore Pakistan
Mohamed Ahmed Aref Ahmed
Specialist, Department of General Surgery, SKMC, UAE
Taher Helmy Aldesouky
Consultant General Surgeon, Saudi German Hospital, Ajman, UAE
Sahar Mughis
Resident, General Surgery Department, SIUT, Karachi Pakistan
Khushboo Chandio
Lecturer, People's Nursing School, LUMHS, Jamshoro Pakistan
Muhammad Aleem Uddin
Assistant Professor of Medicine, Sahara Medical College, Narowal Pakistan
Akbar Hussain
Acting Surgical Specialist, DHQ Hospital, Buner Pakistan
Khadeeja Riaz
MBBS, Medicine Department, Shalamar Medical and Dental College, Lahore Pakistan
Ehsan Ullah
Consultant General and Laparoscopic Surgeon, General Surgery Department, Irfan General Hospital, Charsadda Road Peshawar Pakistan